Diabetes

Although there are several types of Diabetes, Diabetes is a metabolic disorder that involves the release of insulin from the pancreas and its use in the body in order to process and store Glucose (sugar) within the body.  Glucose is an important source of energy, however, too much can negatively impact health.

Types of Diabetes include:

• Type 1
• Type 2
• Gestational
• Prediabetes (Mayo, 2018)

In Type 1 Diabetes, an individual's immune system destroys the cells of the pancreas that produce insulin.  This greatly reduces the amount of insulin being produced.  Without insulin or very little insulin, the amount of blood sugar in the body increases (Mayo, 2018).There is a genetic proponent to Type 1 Diabetes.  Prediabetes is a step to developing Type 2 Diabetes.  In Prediabetes, cells within the body become increasingly resistant to insulin.  Regardless of how hard the pancreas works, it cannot make enough insulin to counteract the insulin resistance (Mayo, 2018).  This leads to blood glucose increasing instead of being used by cells for energy.  At this point, someone has developed Type 2 Diabetes.  There is also a genetic aspect to  Type 2 Diabetes.  Increased weight is also linked to developing Type 2 Diabetes (Mayo, 2018).  Gestational Diabetes occurs due to hormones, produced by the placenta, causing cells to be resistant to insulin.  There are instances where the pancreas is unable to produce enough insulin to counteract the resistance (Mayo, 2018).  Typically, Type 1 Diabetes is diagnosed in children and younger adults, but can be diagnosed at any age.  Type 2 Diabetes is typically diagnosed in adulthood, but  can be also diagnosed in children as well.  Gestational Diabetes is diagnosed during pregnancy (NIH, 2016).

There are approximately 50.2 million people, 18 years or older, in the United States with Diabetes, either diagnosed or undiagnosed (MNT, 2020).  This equates to almost 10% of the population.  More than 25% do not know that they have Diabetes (NIH, 2016).

Symptoms of Diabetes (including Gestational) include:

• Extreme hunger
• Fatigue
• Increased urination
• Increased thirst
• Dry mouth
• Itchy skin
• Blurred vision
• Impotence/Erectile dysfunction

Symptoms of Type 1 Diabetes include:

• Unexplained weight loss
• Nausea
• Vomiting
• Velvety dark skin changes of neck, armpits, and groin (Acanthosis Nigricans)
• Decreased vision

Symptoms of Type 2 Diabetes include:

• Yeast infections
• Slow healing sores or cuts
• Pain or numbness (Mayo, 2018)(WebMD, 2019)

Complications from Diabetes can arise.  Diabetes can play a part in developing conditions such as:

• Heart disease
• Stroke
• Kidney disease
• Eye problems
• Dental disease
• Nerve disease
• Foot problems
• Hearing impairment
• Alzheimer's disease
• Depression (Mayo, 2018)(NIH, 2016)

With Gestational Diabetes, complications that can occur include:

• Excess growth (Large baby)
• Baby more likely to develop Type 2 Diabetes later in life
• Low blood sugar
• Death (Mayo, 2018).

There are many risk factors for Diabetes.  They include:

• For Type 1:
• Family history
• Environmental factors
• Presence of damaging immune system cells (autoantibodies)
• Geography
• For Prediabetes/Type 2:
• Family history
• Weight
• Physical inactivity
• Race
• Age
• Gestational diabetes
• Polycystic Ovary Syndrome
• Hypertension
• High Cholesterol
• Gestational
• Age
• Family history
• Personal history
• Weight
• Race (Mayo, 2018).

With the symptoms occurring rapidly with Type 1 Diabetes, screening tests for Diabetes are often warranted.  With Type 2 Diabetes and Prediabetes, there are guidelines set forth by the American Diabetic Association to prompt screening for Diabetes including:

• BMI >25, regardless of age
• 45 years old or older
• Any woman that had Gestational Diabetes during a pregnancy
• Diagnosis of Prediabetes (Mayo, Diagnosis, 2018).

Tests used to diagnose Diabetes include:

• Glycated Hemoglobin (A1C) test
• Random blood sugar
• Fasting blood sugar
• Oral glucose tolerance test
• Urine checked for ketones, if Type 1 is suspected 
• Glucose challenge test, used to diagnose Gestational Diabetes

There are several treatments that can be used with Diabetes.  These treatments include:

• For Type 1
• Insulin
• Injections
• Insulin pump
• Blood sugar checks
• Carbohydrate Counting
• For Type 2
• Lifestyle changes
• Exercise
• Weight loss
• Well-balanced diet
• Minimal alcohol 
• Medications
• Metformin
• SGLT2 inhibitors
• GLP-1 receptor agonists
• Bariatric surgery (Mayo, 2018).

With all types of Diabetes, an individual should be aware of the symptoms of hypoglycemia, hyperglycemia, Diabetic Ketoacidosis, and Hyperglycemic Hyperosmolar Nonketotic Syndrome as they all can constitute an emergency. Individuals with Diabetes should be aware of the symptoms of each of these conditions.   Hypoglycemia, or low blood sugar, occurs when someone's blood sugar falls below a target level.  Hyperglycemia occurs when blood sugar raises above a target level.  Diabetic ketoacidosis occurs when the body breaks down fat for energy producing ketones.  Hyperglycemic Hyperosmolar Nonketotic Syndrome occurs with Type 2 Diabetes when the blood sugar level becomes so high that an individuals' blood thickens (Mayo, 2018).

Symptoms of Hypoglycemia include:

• Sweating
• Shakiness
• Weakness
• Hunger
• Dizziness
• Headaches
• Blurred vision

Symptoms of Hyperglycemia include:

• Frequent urination
• Increased thirst
• Dry mouth
• Blurred vision
• Fatigue
• Nausea

Symptoms of Diabetic Ketoacidosis include:

• Loss of appetite
• Weakness
• Fever
• Numbness
• Stomach pain
• Sweat, fruity breath

Symptoms of Hyperglycemic Hyperosmolar Nonketotic Syndrome include:

• Blood sugar 600 mg/dL or higher
• Fever
• Dry Mouth
• Extreme thirst
• Drowsiness
• Confusion
• Vision loss
• Hallucinations (Mayo, 2018).

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For more resources on Diabetes, visit the American Diabetic Association website at https://www.diabetes.org/resources

Mayo Clinic. (2018)  Diabetes.  Mayo Clinic.  Retrieved from https://www.diabetes.org/resources

Medical News Today. (2020) Diabetes: Symptoms, treatment and early diagnosis.  Medical New Today.  Retrieved from https://www.medicalnewstoday.com/articles/323627

NIH. (2016) What is Diabetes?  National Institute of Diabetes and Digestive and Kidney Diseases.  Retrieved from https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes

WebMD. (2018) Early Signs and Symptoms of Diabetes: How To Tell If You Have It.  WebMD.  Retrieved from https://www.webmd.com/diabetes/guide/understanding-diabetes-symptoms

Depression

Depression is a mood disorder that is also known as Major Depressive Disorder or Clinical Depression.  Because depression is comprised of a persistent feeling of sadness and a loss of interest in activities it is more than feeling sad for a couple days (Mayo, 2020).  The symptoms of depression can affect and individual's feelings, thoughts, and daily activities (NIH, 2020).

The symptoms of depression can fluctuate in severity.  An individual can have episodes of symptoms.  The episodes last at least two weeks but can last for months or years (MNT, 2020).  Symptoms of depression include:

• Persistent feelings of sadness, anxiety, hopelessness, worthlessness.
• Feelings of irritability or angry outbursts.
• Loss of interest in activities.
• Decreased energy or fatigue.
• Difficulty concentrating, remembering or making decisions.
• Sleep disturbances such as difficulty sleeping, early morning awakening, oversleeping.
• Appetite and/or weight changes (increased or decreased).
• Aches or pains not explained by other conditions.
• Increase in purposeless physical activity (pacing back and forth, etc).
• Slowed movements and speech.
• Suicidal ideations or suicide attempts (Mayo Clinic, 2020)(APA, 2017)(NIH, 2018).

About 6.7% of adults are affected by depression in any given year and 16.6% of people experience depression during their lifetime.  (APA, 2017).  Also in any given year, 16.1 million people in the United States are affected by depression (MNT, 2020).  Women are about twice as likely  to experience depression than men and about one third of women experience an episode of depression in their lifetime (APA, 2017)(MNT, 2020).

Risk factors of depression include:

• Genetics
• Brain chemistry
• Environmental factors
• Psychological and social factors
• Hormones
• Personality
• Acute stress
• Lack of coping strategies
• Some medications
• Recreational drugs
• Head injury
• Chronic condition
• Persistent pain (MNT, 2020)(APA, 2017)(Mayo Clinic, 2020).

Depression is most often first seen in adulthood, although depression can occur at all ages.  In adults, depression can occur along with other medical conditions.  Medications for these conditions may impact depression (NIH, 2018).

In order to diagnose depression, several things should be done including:

• Physical exam
• Lab tests
• Psychiatric evaluation
• The Hamilton Depression Rating Scale
• The Beck Depression Inventory
• Use of DSM-V (Diagnostic & Statistical Manual of Mental Disorders, 5th edition) (MNT, 2020)

According to the DSM-V, five or more symptoms must be present during a two week period, as well as be a change in prior functioning with one of the symptoms being either a depressed mood or loss of interest in activities or pleasure (FMHI, 2018).

Treatments for depression include:

• Support
• Psychotherapy
• Medications
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Monoamine Oxidase Inhibitors (MAOIs)
• Tricyclic antidepressants
• Atypical antidepressants
• Selective Serotonin & Norepinephrine Reuptake Inhibitors (SSNRIs) 
• Electroconvulsive therapy  
• Transcranial Magnetic Stimulation (MNT, 2020)(APA, 2017)(Mayo Clinic, 2020)-.

There are forms of depression that are somewhat different from Major Depressive Disorder.

• Persistent Depressive Disorder:  also known as Dysthymia and is less severe and more chronic as it lasts for at least two years.
• Postpartum Depression: occurs during pregnancy or after childbirth.
• Psychotic Depression: consists of severe depression and a form of psychosis (delusions or hallucinations).
• Major Depressive Disorder with Seasonal Pattern:  onset is during winter months with less natural sunlight.
• Bipolar Depression:  Depression fluctuates with mania (extreme high euphoria).
• Cyclothymic Disorder:  involves symptoms that are milder than Bipolar Depression.

If you are experiencing depression, find support and seek medical attention.  If you are considering suicide, find support, seek medical attention, or contact the National Suicide Hotline at 1-800-273-8255.

Watch the Youtube video below.  Click like, share, and subscribe.  Also, in the blog, at right of articles, click follow for updates on articles.

APA. (2017) What is Depression?  American Psychiatric Association.  Retrieved from https://www.psychiatry.org/patients-families/depression/what-is-depression

FMHI. (2018) DSM-5 Criteria: Major Depressive Disorder.  Florida Mental Health Institute. Retrieved from  http://www.medicaidmentalhealth.org/_assets/file/Guidelines/2017-
2018%20Treatment%20of%20Adult%20Major%20Depressive%20Disorder.pdf

Mayo Clinic. (2020) Depression (Major Depressive Disorder)  Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/depression/diagnosis-treatment/drc-20356013

MNT. (2020) What is Depression and What Can I Do About It?  Medical News Today.  Retrieved from https://www.medicalnewstoday.com/articles/8933#triggers

NIH. (2018) Depression.  National Institue of Health.  Retrieved from https://www.nimh.nih.gov/health/topics/depression/index.shtml

Opioid Use Disorder

Opioids can occur naturally or be made in laboratories (synthetic).  Opioids, when ingested, interact with opioid receptors that are located on neurons in both the brain and the body.  Due to the interaction between the opioid and the neurons, any pain is reduced (APA, 2018).  Opioids have both analgesic (pain relief) and Central Nervous System depressant effects (Strain, 2020).  Naturally occuring opiates (Heroin, Opium, Morphine, Codeine) and Synthetic Opiates (Oxycodone, Hydrocodone, Fentanyl, Tramadol, and Methadone) are  both classified as opioids (Strain, 2020).  Some opioids are stronger than others.  Fentanyl is 50 - 100 times more potent than other opioids (Strain, 2020).

There are medical uses for opioid use such as treatment of acute pain, cancer treatment, palliative care, and end of life care (APA, 2018).  When used at increased amounts, for an increased amount of time, for reasons other than being prescribed by a medical professional or longer than what it was prescribed to be, a person can develop an addiction to opioids.  Taking opioids in increased amounts activated the reward system in the brain which is what causes the "high" that people feel when taking opioids.  When opioids are abused, they "high-jack" the reward system in a way that normal activities of the reward system are foregone in favor of the "high" obtained with opioid use.  With continued use, a person becomes physically dependent fairly quickly and develops tolerance.  This tolerance causes higher doses to be needed in order to create the same ¨high¨ as lower doses had previously created.  Withdrawal occurs when use of the drug is either reduced or stopped (PCSS, 2017).

In 2015, 3.8 million people aged 12 and older in the United States reported past month use of prescribed pain medication with 2 million having Opioid Use Disorder or dependence diagnosable according to the DSM-IV (Diagnostic and Statistical Manual of Mental Disorder)(Strain, 2020).  Seventy two thousand people died from drug overdoses in 2017 in the United States (APA, 2018).

Risk Factors include:

• Prior history of Substance Use Disorder
• Younger age
• More severe pain
• Co-morbid mental disorders
• Genetic factors
• Environmental factors 
• Ease if access (PCSS, 2017)(Strain, 2020)

Diagnosis of Opioid Use Disorder consists of using criterion in the DSM-V.  Two or more criterion should be present within a 12-month period including:

• taking opioids longer than prescribed
• desire and/or trying to control use
• spending a lot of time obtaining, using, and recovering from use
• craving for opioid use
• failure to meet obligations due to opioid use
• persistent or recurrent social or interpersonal interactions due to opioid use
• giving up previous activities due to opioid use
• Tolerance
• Withdrawl (Strain, 2020) 

Several tests can be done to assist in diagnosing Opioid Use Disorder.  Diagnosis tools:

• Substance use history
• Physical Exam
• Drug screen
• Complete Blood Count (Strain, 2020)

Treatments include:

• Medically Assisted Treatment (MAT)
• Methadone
• Buprenorphine
• Naltrexone
• Opioid Treatment Centers
• Coordinated Care
• Recovery support system
• Behavioral interventions (PCSS, 2017)(SAMSA, 2020)

Prevention efforts:

• Naloxone - opioid reversal medication
• Individuals should lock up all medications to remove them from reach of others. (PCSS, 2017)

If you, a family member, friend or neighbor are dealing with Opioid Use Disorder:

• please seek assistance in your local area, 
• call SAMHSA´s National Hotline, 1-800-622-HELP
• Go to SAMHSA website, https://www.samhsa.gov/find-treatment

APA. (2018) Opioid Use Disorder.  American Psychiatric Association.  Retrieved from https://www.psychiatry.org/patients-families/addiction/opioid-use-disorder/opioid-use-disorder

PCSS (2017) Opioid Use Disorder: What is Opioid Addiction? Providers Clinical Support System.  Retrieved from https://pcssnow.org/resource/opioid-use-disorder-opioid-addiction/

SAMHSA.(2020)  Medication and Counseling Treatment.  Substance Abuse and Mental Health Service Administration.  Retrieved from https://www.samhsa.gov/medication-assisted-treatment/treatment

Strain, E. (2020) Opioid Use Disorder: Epidemiology, pharmacology, clinical manifestations, course, screening, assessment and diagnosis. UpToDate.  Retreived from https://www.uptodate.com/contents/opioid-use-disorder-epidemiology-pharmacology-clinical-manifestations-course-screening-assessment-and-diagnosis

Ovarian Cancer

The female reproductive system consists of the uterus, two Fallopian Tubes, and two ovaries.  The ovaries.  The ovaries are small and produce eggs (ovum) and the hormones estrogen and progesterone (Mayo, 2020).  As with other parts of the body, cancer can develop in the ovaries.  Although deaths from ovarian cancer has declined over the past twenty years, it is still the fifth leading cause of cancer deaths in women in this county (MNT, 2020).

Because, most often, cancer starts in the outer lining of the ovary, also called the epithelium, there are few or no early symptoms.  Because of the types of symptoms that do occur, the condition is often misdiagnosed as conditions such as Pre-Menstrual Syndrome, Irritable Bowel Syndrome, or a temporary bladder problem (MNT).   Symptoms of ovarian cancer include:

• abdominal bloating or swelling
• quickly feeling full when eating
• weight loss
• pelvic discomfort
• changes in bowel habits
• frequent urination
• pelvic pain
• pelvic pressure
• unexpected vaginal bleeding
• gas
• nausea
• vomiting
• loss of appetite (Mayo)(MNT)(Medline, 2019).

Risk factors include:

• family history: having a close relative with ovarian or breast cancer
• reproductive history
• dietary factors
• use of Talcum powder 
• gene mutations
• using fertility treatment
• smoking (ACS, 2020)(MNT)(Mayo).

There are three types of ovarian cancer.  They include:

• Epithelial:  occurs in the outside layer of the ovary (90% of ovarian cancers)
• Stromal:  occurs in the ovarian tissue (7% of ovarian cancers)
• Germ cell: occurs in egg producing cells.  Are often benign, but when malignant, treatment is effective in 90% of cases. (MNT)(Mayo).

Along with history and physical exam, there are several tests that can be done to diagnose ovarian cancer including:

• imaging tests
• ultrasound
• MRI
• CT scan
• laparoscopy
• biopsy
• barium enema xray
• chest xray
• PET scan
• colonoscopy (ACA, 2018)(MNT).

Staging, how far the cancer has progressed, is determined after testing is done.

Treatments used depend on the type and stage of the cancer, the patient's age, the patient's general health, patient preference, and the accessibility and affordability of treatment (MNT).  Treatments include:

• surgery
• chemotherapy
• targeted therapy
• palliative care
• radiation therapy
• immunotherapy (Mayo)(MNT).

Genetic testing can be done to search for gene mutations that make some individuals more susceptible to certain cancers such as ovarian, breast in both men and women, prostate, pancreatic and melanoma cancers (Mayo, 2020).  The BRCA1 and BRCA2 genes are the genes where mutations can increase someone's likelihood of certain cancers.  Finding out that someone has the mutation of one or both of those genes does not mean that the individual will indeed develop cancer, however, there is an increased susceptibility.

If you have a family history of breast cancer and/or ovarian cancer, please consider speaking with your doctor and getting genetic testing done.

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https://www.youtube.com/watch?v=hs1X4uYYDGk&t=21s


ACS. (2020) Ovarian Cancer Risk Factors.  American Cancer Society.  Retrieved from https://www.cancer.org/cancer/ovarian-cancer/causes-risks-prevention/risk-factors.html

Mayo Clinic. (2020) Ovarian Cancer.  Mayo Clinic.  Retrieved from https://www.mayoclinic.org/diseases-conditions/ovarian-cancer/symptoms-causes/syc-20375941

Mayo Clinic. (2020) BRCA gene test for breast and ovarian cancer risk.  Retrieved from https://www.mayoclinic.org/tests-procedures/brca-gene-test/about/pac-20384815

Medical News Today. (2020) What is Ovarian Cancer?  Medical News Today.  Retrieved from https://www.medicalnewstoday.com/articles/159675#symptoms

Medline Plus. (2020) Ovarian Cancer.  Medline Plus.  Retrieved from https://medlineplus.gov/ovariancancer.html

Coronavirus (COVID - 19)

Coronavirus (COVID - 19) is a virus that is spread through saliva droplets and nasal discharge.  These can spread by coughing, sneezing, or talking (WHO, 2020).  Close personal contact increases the spread of the virus as does touching facial areas and not washing hands (NCDHHS, 2020).  It is also thought that touching a surface that has the surface then touching face or mouth can also spread the virus (CDC, 2020).

Symptoms of Coronavirus may appear 2-14 days after being exposed and includes:

• fever
• cough
• shortness of breath
• fatigue
• aches and pains
• shaking with chills
• new loss of taste or smell
• diarrhea
• nausea
• vomiting
• congestion
• running nose
• sore throat (WHO, 2022)(NCDHHS, 2020)(CDC, 2020).

Symptoms that would constitute being an emergency include:

• trouble breathing
• persistent pain or pressure in chest
• new confusion
• inability to arouse
• blush lips or face  (CDC, 2020).

When an individual becomes infected, they are more likely to experience mild or moderate symptoms and not require treatment.  People who are more susceptible to becoming infected with Coronavirus include:

• elderly
• individuals with underlying medical issues
• cardiovascular disease
• Diabetes
• chronic respiratory disease
• asthma
• COPD
• Cancer (WHO).

If you suspect you are experiencing symptoms of Coronavirus, call your doctor for next steps. 

There are several things that people can do to protect themselves and those around them from Coronavirus.  These things include:

• washing hands with soap and water
• use hand sanitizer (in conjunction with washing hands)
• maintain a minimum of 3 feet (6 feet recommended) between yourself and others (especially if they are coughing and/or sneezing)
• don't touch your face your mouth and nose when coughing and sneezing
• self-isolate if exhibiting symptoms
• don't smoke
• social isolation  (WHO, 2020).

Currently, there are viral and antibody tests that can test for Coronavirus.  Viral tests test for current infection and antibody tests test for a previous infection (CDC, 2020).

There are now vaccines for Coronavirus available.  There are three types of vaccines available.  Pfizer and Moderna have developed mRNA vaccines which teach cells how to make a protien which will trigger the body's immune response.  Johnson & Johnson has created a viral vector vaccine that presents a modified version of a different virus that delivers instructions on how to fight the COVID virus.  (CDC, 2022).  Pfizer and Moderna also provide a bivalent vaccine that also include components of the original COVID virus as well as the omicron variant  (CDC, 2023)  To hear about an experience about receiving a COVID vaccine watch the video below.

If someone has tested positive, typically symptoms will go away on their own, but medications to reduce fever or pain may be given.  Drinking fluids and getting rest are important steps (AAFP, 2020).

To track cases of Coronavirus go to the interactive map provided by John Hopkins at https://coronavirus.jhu.edu/map.html

To complete a self-check to help determine whether you should be tested, go to https://www.cdc.gov/coronavirus/2019-ncov/index.html

UPDATED 2/12/2023

Anerican Academy of Family Physicians. (2020)  Coronavirus Disease (COVID - 19).     

                Familydoctor.  Retrieved from https://familydoctor.org/condition/coronavirus/

CDC. (2020) Coronavirus (COVID - 19).  Centers for Disease Control and Prevention.  Retrieved                      from  https://www.cdc.gov/coronavirus/2019-ncov/index.html

CDC. (2023)  COVID Bivalent Vaccine Boosters.  Centers for Disease Control and Prevention.  Retrieved from https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/covid-19-bivalent-vaccine-boosters

CDC. (2022)  Overview of COVID- 19 Vaccines.  Centers for Disease Control and Prevention.  Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/overview-COVID-19-vaccines.html

CDC. (2020)  Symptoms of Coronavirus.  Centers for Disease Control and Prevention.  Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html

CDC. (2020).  What you should know about COVID-19 to Protect Yourself and Others. Centers for Disease Control and Prevention.  https://www.cdc.gov/coronavirus/2019-ncov/downloads/2019-ncov-factsheet.pdf

John Hopkins University and Medicine. (2020) Coronavirus Resource Center. John Hopkins                                University and Medicine.  Retrieved from https://coronavirus.jhu.edu/map.html

NCDHHS. (2020) What is COVID - 19?  North Carolina Department of Health and Human Services.

                Retrieved from https://www.ncdhhs.gov/divisions/public-health/coronavirus-disease-2019- covid-19-response-north-carolina/what-covid-19

WHO. (2020)  Coronavirus.  World Health Organization.  Retrieved                                                                      from https://www.who.int/health-topics/coronavirus#tab=tab_3

Anxiety

Although it is normal to experience some anxiety in situations such as public speaking or test taking, when dealing with anxiety disorders, it can alter how an individual lives their life.  Anxiety stems from the fight or flight response and was useful in determining when someone was in danger.  Because individuals in 2020 are not typically running from large animals and the like, the full fight or flight response is not typically necessary.

 Anxiety disorders develop when the length or severity of the anxiety is disproportionate with the stimulus (Felman, 2018).  Anxiety involves excessive nervousness, fear, apprehension and worry (Felman, 2018).  Common types of anxiety disorders include:

• Generalized Anxiety Disorder
• Panic Disorder
• Phobia Related Disorder
• Agoraphobia (NIMH, n.d.)

There are approximately 40 million people in the United States  who are affected by an anxiety disorder, but only about 36.9% of the receive treatment (Felman, 2018).  Anxiety disorder can occur any age and affects more women than men (Healthline, 2018).  Some possible causes of anxiety disorders include:

• Environmental stressors
• Genetics
• Medical factors
• Brain chemistry
• Withdrawal from an illicit drug (Felman, 2018).

Generalized Anxiety Disorder (GAD) lasts most days for at least six months along with three or more symptoms.  During this time, an individual has excessive anxiety which will negatively impact their life.  When struggling with GAD, it is difficult to interrupt the worry cycle, even when there is the realization that there is an imbalance with the severity of the situation and the level of worry.  With mild or moderate disorders, it is possible to function socially, however, as the severity of the disorder increases, the ability to function socially typically decreases (ADAA, 2018).  Symptoms of GAD include:

• Restlessness
• Difficulty concentrating
• Muscle tension
• Difficulty controlling feelings of worry
• Sleep issues
• Sense of impending danger
• increased heart rate 
• Feeling weak or tired
• GI issues (AADA, 2018)(n.d.)

Panic Disorder is characterized by an intense fear coming on rapidly and peaking in several minutes.  These episodes are referred to as panic attacks.  Because they can occur unexpectedly or triggered by something, an individual can often worry about when the next panic attack will occur.  They may also try to avoid places or situations (n.d.).  Some symptoms of Panic disorder include:

• Heart palpitations
• Sweating
• Trembling
• Shortness of breath
• Feelings of impending doom
• Feelings of being out of control
• Confusion (Felman, 2018)(n.d.)

Phobia Related Disorder is the irrational fear of a situation, animal, or thing.  There are individuals who have phobias of heights, needles, flying, bridges, dogs, etc.  Although it is natural to have some fear regarding these things, having a disproportionate amount of fear can cause distress.  Most phobias develop before 30 years old and may develop after a traumatic experience, or learned from a family member (Brazier, 2017).  With a phobia, people may experience:

• Irrational worry about situation or thing
• Actively trying to avoid situation or thing
• Immediate irrational fear when encountering situation or thing
• Abnormal breathing
• Increased heart rate
• Chest pains
• Trembling
• Butterflies in stomach (Brazier, 2017)(n.d.).

Agoraphobia is comprised of both a fear and avoidance of places and situations where flight or escape may be difficult.  It may also be believed that help would not be available in the event that they became trapped.  There may also be the fear of crowds, bridges, or being outside alone (McIntosh, 2017).  Several things to remember about Agoraphobia are:

• Can develop after one or more panic attacks
• Can lead to various fears
• Can make it difficult to leave home
• Can improve with treatments such as antidepressants or anti-anxiety medications (2017).

Other types of Anxiety disorders include:

• Selective mutism:  An anxiety that occurs in childhood causing them to not speak in certain situations (2019).  Is often diagnosed with other anxiety disorders (n.d.).
• Social Anxiety Disorder:  Anxiety stems from an intense fear of social situations and public humiliation.  This causes an avoidance of social situations (2019).
• Separation Anxiety:  Although commonly thought of with children, can also occur in adults.  Anxiety occurs when separated from someone who is important to the individual.  There can be a feat that harm will occur to the person they are attached to and nightmares as a result (n.d.).

There are several treatments available for anxiety:

• Psychotherapy:  Geared towards specific Anxiety.
• Cognitive Behavioral Therapy:  A type of psychotherapy that focuses on teaching new thinking, behaviors and reactions towards anxiety.
• Anti-Anxiety Medications:  Typically Benzodiazepines are used to relieve anxiety.
• Antidepressants:  Improves the way the brain use chemicals to change mood (n.d.).

REFERENCES

AADA. (2019) Generalized Anxiety Disorder (GAD).  Anxiety and Depression Association of America.  Retrieved from https://adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad

Brazier, Y. (2017)  Everything You Need to Know About Phobias.  Medical News Times.  Retrieved from https://www.medicalnewstoday.com/articles/249347.php

Felman, A. (2018)  What to Know About Anxiety.  Medical News Times.  Retrieved from https://www.medicalnewstoday.com/articles/323454.php

Holland, K. (2018)  Everything You Need to Know About Anxiety.  Healthline.  Retrieved from https://www.healthline.com/health/anxiety 

McIntosh, J. (2017)  What you Need to Know About Agoraphobia.  Medical News Timed.  Retrieved from https://www.medicalnewstoday.com/articles/162169.php

National Institutes of Mental Health. (n.d.)  Anxiety Disorders.  National Institutes of Health.  Retrieved from https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml#part_145336

Lupus

Lupus is an autoimmune disease that affects the entire body.  The immune system attacks both tissues and organs within the body, causing inflammation.  Parts of the body that are affected include joints, skin, kidneys, blood cells, brain, heart and lungs, among others (Mayo Clinic, 2023).

There are four forms of lupus:

• Systemic
• Cutaneous
• Drug-induced
• Neonatal (Lupus Foundation, 2023).

Systemic Lupus makes up 70% of cases and involves a major organ in about half of the cases.  Cutaneous Lupus involves the skin and makes up 10% of cases.  Drug Induced Lupus is caused with high doses of some medications and makes up 10% of cases and can diminish after the medication has been stopped.  Neonatal Lupus occurs when the antibodies of the mother impacts the fetus causing symptoms at birth that subside within six months (Lupus Foundation, 2023).  

Risk factors of developing Lupus include:

• Gender
• Age
• Race
• Family history (Lupus Foundation, 2023) (Mayo Clinic, 2023).

There are approximately 1.5 million people in the United States diagnosed with Lupus and is more common in women of childbearing age.  In fact, 90% of those diagnosed with Lupus are women.  The most common age range for diagnosis is between 15 and 44 years old (Lupus Foundation, 2023).  Of individuals who have Lupus, 1 in 3 have also been diagnosed with another autoimmune disorder (Lupus Foundation, 2023).  Lupus is more common in women of color.  African American women have a 2 to 3 times higher prevalence rate than White women and Latina, Asians, and Native Americans also have a higher prevalence rate (Medline, 2019).  Genetics plays a role  in developing Lupus.  Genetic variants can impact  both who develops Lupus and how severe it is (Medline, 2016).  

There are several symptoms that someone with Lupus can experience.  The symptoms include:

• Fatigue
• Fever
• Joint pain
• Joint stiffness
• Joint swelling
• Butterfly shaped facial rash
• Photosensitive skin lesions
• Raynaud's Phenomenon
• Shortness of breath
• Chest pain
• Dry eyes
• Headaches
• Confusion
• Memory loss
• Hair loss
• Swollen glands (Mayo Clinic, 2023)(Medline, 2019).

There are several tools clinicians use to diagnose Lupus.  Lupus can be mistaken for other diseases so it is important that certain tests are done.  When considering Lupus, it is important to complete:

• Medical history
• Complete exam
• Blood tests
• Complete Blood Count
• Erythrocyte Sedimentation Rate
• Liver and Kidney tests
• Urinalysis
• Antinuclear Antibody test
• Skin biopsy
• Kidney biopsy (Mayo, Clinic 2023) (Medline, 2016)

An individual may experience complications due to Lupus.  These may include:

• skin scarring
• heart attack
• joint deformities
• bone fractures
• kidney failure
• cataracts
• avascular necrosis
• pregnancy complications
• cardiovascular disease
• headaches
• dizziness
• behavior changes
• vision problems
• seizures (Mayo Clinic, 2023) (Johns Hopkins, 2023)

Once diagnosed, there are treatments that can be used to control symptoms, as there is no cure.  Because Lupus affects many systems in the body, it is often required to see a team of doctors including a Primary Care Physician, Rhuematologist and others as needed.  

Medications used include:

•  Non-steroidal anti-inflammatory drugs (NSAIDS)
• Antimalarial drugs
• Corticosteriods
• Biologic Immunosuppressants
• Rituximab (Mayo Clinic, 2023)

These drugs are used to:

• decrease swelling
• decrease pain
• prevent flares
• decrease damage to joints (Medline, 2016)

There are lifestyle changes individuals can make to help cope with their Lupus symptoms in addition to their treatment.  Having regular checkups is important to prevent flare ups.  Wearing sun protective items (hat, long sleeves, etc) amd using sunscreen is important.  Regular exercise and a healthy diet are also important.  Smoking can increase the impact of Lupus on the cardiovascular system, so not smoking will help decrease the affects of Lupus on the heart and blood vessels (Mayo Clinic, 2023).

To learn more about Lupus, watch our youtube video.

If you have been diagnosed with Lupus and have questions, either contact your Primary Physician or contact a health educator through the Lupus Foundation at https://www.lupus.org/resources/health-educator .

Updated 3/11/2023

References

Johns Hopkins Medicine. (2023) Lupus Complications and Prognosis.  Johns Hopkins Medicine.  Retrieved from  https://www.hopkinsmedicine.org/health/conditions-and-diseases/lupus/lupus-complications-and-prognosis

Lupus Foundation. (2023)  What is Lupus?  Lupus Foundation.  Retrieved from https://www.lupus.org/resources/what-is-lupus

Mayo Clinic.  (2023) Lupus.  Mayo Clinic.  Retrieved from https://www.mayoclinic.org/diseases-conditions/lupus/symptoms-causes/syc-20365789

Medline. (2016) Lupus.  US National Library of Medicine.  Retrieved from https://medlineplus.gov/lupus.html